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P - 35593Building Inspections 763-572-3604 763-502-4977 FAX DATE�� \l.L_ SITE ADDRESS� THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF [MPROVEMENT_ BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 � � I YOUR E-MAIL ADI �-�`-i �'t� �V L= 1.5 � � r ; ❑ OWNER �'CONTRACTOR NAME: r ' ADDRESS:1��_ PHONE: 7#:,��— 'T2`S�— �O� NAME: IJO[� �,. TVL�,r� o�i^ STATE LICENSE # MI�I ��_� ` . ADDRESS: ��� �2�ITi�- GT Permit No.'��� �—�. 4� Received By: Date Rec'd: � l� -�� I il L��'/ STATE ML,IZIP, CERT NIJMBER — CiTY STATE�ZIP �����-G. ��7G�'R�� �,SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STOR[ES ❑ ADDITION O GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ROOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION � MAINTENANCE/REPAIR � REMODELING ROOFING � NUMBER OF SQUARES �_ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl � Aluminum ❑ Other ❑ HOUSE ONLY �HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & HEIGHT BASEMENT REMODELING SUBMIT: I . Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION (NCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: I. Site Plan/Survey showing the existing sWctures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Per[nit Fee Plan Review Fire Surcharge Surcharge License Surcharge - - SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due �� $ � � $ ��c�0 $ $ $ $ $ $ • See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ___ ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks pavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in a ordance with the approved plan in the case o 11 work w qu viy�v d approval of pla �^7`�� S[GNATURE OF APPLICANT y/�/i PRINT NAME�y�Q r��rA —+' �'I/I I DATE APPROVAL INSPECTOR SI NAT � / ��